Michael Albert Odonnell, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

DO01239 Issued in RI

Practice address

164 Summit Ave
Providence, RI 02906-2853

Phone

(401) 793-4489

NPI assigned

May 10, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Internal Medicine

Education

University of New England, College of Osteo Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The Miriam Hospital Hospital, Providence, RI, CCN 410012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifespan Physician Group, Inc.

  • General Practice Physician
  • Providence, RI
  • NPI 1407116643
  Medicare reassignment Care Compare group NPD
• Lifespan Physician Group, Inc.

  • Emergency Medicine Physician
  • Providence, RI
  • NPI 1568325678
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• The Miriam Hospital

  • General Acute Care Hospital
  • Providence, RI
  • NPI 1487649430
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1487276754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541",
            "telephone_number": "401-444-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-4489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODONNELL",
        "first_name": "MICHAEL",
        "middle_name": "ALBERT",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-10",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "DO01239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ocean State Urgent Care at St Joseph Health Center LLC
• Sharon Ochanda, NP
• Tiana T Ochoa Teo, LICSW
• Anna Ochsner, MD
• Nkenna Odom, MD
• Ifeoma C. Odukwe, MD
• Olutayo A. Odusanwo, DMD
• Jane G Ofarrell, LICSW
• Patrick Ofori-Appiah, LCSW
• Laura M Ofstead, MD

• Internal Medicine Physician in Providence, RI
• Providers in Providence, RI by specialty
• Internal Medicine Physician in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.